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Sample Consent to: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records - Alabama
Sample Consent to: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records is a legal document that was released by the Alabama Department of Mental Health - a government authority operating within Alabama.
FAQ
Q: What is the purpose of the consent?A: To authorize disclosure of confidential substance abusepatient records to a third-party payer.
Q: Who is the consent given to?A: The consent is given to a third-party payer.
Q: What kind of records are being disclosed?A: Confidential substance abuse patient records.
Q: Is this consent specific to Alabama?A: Yes, this consent is specific to Alabama.
Form Details:
- Released on January 1, 2018;
- The latest edition currently provided by the Alabama Department of Mental Health;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.
Download Sample Consent to: Third-Party Payer Authorizing Disclosure of Confidential Sud Patient Records - Alabama
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